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Soloukey S, Vincent AJPE, Smits M, De Zeeuw CI, Koekkoek SKE, Dirven CMF, Kruizinga P. Functional imaging of the exposed brain. Front Neurosci 2023; 17:1087912. [PMID: 36845427 PMCID: PMC9947297 DOI: 10.3389/fnins.2023.1087912] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
When the brain is exposed, such as after a craniotomy in neurosurgical procedures, we are provided with the unique opportunity for real-time imaging of brain functionality. Real-time functional maps of the exposed brain are vital to ensuring safe and effective navigation during these neurosurgical procedures. However, current neurosurgical practice has yet to fully harness this potential as it pre-dominantly relies on inherently limited techniques such as electrical stimulation to provide functional feedback to guide surgical decision-making. A wealth of especially experimental imaging techniques show unique potential to improve intra-operative decision-making and neurosurgical safety, and as an added bonus, improve our fundamental neuroscientific understanding of human brain function. In this review we compare and contrast close to twenty candidate imaging techniques based on their underlying biological substrate, technical characteristics and ability to meet clinical constraints such as compatibility with surgical workflow. Our review gives insight into the interplay between technical parameters such sampling method, data rate and a technique's real-time imaging potential in the operating room. By the end of the review, the reader will understand why new, real-time volumetric imaging techniques such as functional Ultrasound (fUS) and functional Photoacoustic Computed Tomography (fPACT) hold great clinical potential for procedures in especially highly eloquent areas, despite the higher data rates involved. Finally, we will highlight the neuroscientific perspective on the exposed brain. While different neurosurgical procedures ask for different functional maps to navigate surgical territories, neuroscience potentially benefits from all these maps. In the surgical context we can uniquely combine healthy volunteer studies, lesion studies and even reversible lesion studies in in the same individual. Ultimately, individual cases will build a greater understanding of human brain function in general, which in turn will improve neurosurgeons' future navigational efforts.
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Affiliation(s)
- Sadaf Soloukey
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands,Department of Neurosurgery, Erasmus MC, Rotterdam, Netherlands
| | | | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Chris I. De Zeeuw
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands,Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, Amsterdam, Netherlands
| | | | | | - Pieter Kruizinga
- Department of Neuroscience, Erasmus MC, Rotterdam, Netherlands,*Correspondence: Pieter Kruizinga,
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2
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Xiong Z, Luo C, Wang P, Hameed NUF, Song S, Zhang X, Wu S, Wu J, Mao Y. The Intraoperative Utilization of Multimodalities Could Improve the Prognosis of Adult Glioblastoma: A Single-Center Observational Study. World Neurosurg 2022; 165:e532-e545. [PMID: 35760324 DOI: 10.1016/j.wneu.2022.06.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In recent years, numerous neurosurgical multimodal techniques have been utilized to maximize tumor resection safely and effectively. However, the synergetic effects of neurosurgical multimodalities on the survival of glioblastoma patients remain unclear. This study evaluated the role of intraoperative utilization of multimodalities in glioblastoma patients. METHODS Data of 912 adult patients with glioblastoma were obtained from the Huashan Glioma Registry. The utilization of fewer than 2 (multimodality value < 2) intraoperative multimodal techniques was defined as the nonmultimodal group. In contrast, the utilization of 2 or more (multimodality value ≥ 2) intraoperative multimodal techniques was regarded as the multimodal group. The prognosis of the 2 cohorts was compared and further stratified based on the diagnosis date (2010-2014 or 2015-2019) to reveal the role of the application of multimodal techniques. RESULTS The median overall survival (OS) and progression-free survival of glioblastoma patients were 17.70 months and 12.03 months, respectively. The OS time of the multimodal group was noticeably longer than that of the nonmultimodal group (21.0 months vs. 16.0 months, P < 0.001). Multimodal techniques were more frequently applied in surgery in the 2015-2019 group than in the 2010-2014 group. The popularity of multimodal techniques contributed to significant improvement in the prognosis of glioblastoma patients from 2010-2014 to 2015-2019 (OS, 16.0 months vs. 22.0 months, P < 0.001). CONCLUSIONS This study indicated that the utilization of intraoperative multimodal techniques improved the extent of resection and elevated the survival for adult glioblastoma patients.
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Affiliation(s)
- Zhang Xiong
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - Chen Luo
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - Peng Wang
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - N U Farrukh Hameed
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sida Song
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - Xiaoluo Zhang
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - Shuai Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - Jinsong Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China
| | - Ying Mao
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Brain Function Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China.
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3
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Impact of combined use of intraoperative MRI and awake microsurgical resection on patients with gliomas: a systematic review and meta-analysis. Neurosurg Rev 2021; 44:2977-2990. [PMID: 33537890 PMCID: PMC8592967 DOI: 10.1007/s10143-021-01488-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/29/2020] [Accepted: 01/25/2021] [Indexed: 10/29/2022]
Abstract
Microsurgical resection of primary brain tumors located within or near eloquent areas is challenging. Primary aim is to preserve neurological function, while maximizing the extent of resection (EOR), to optimize long-term neurooncological outcomes and quality of life. Here, we review the combined integration of awake craniotomy and intraoperative MRI (IoMRI) for primary brain tumors, due to their multiple challenges. A systematic review of the literature was performed, in accordance with the Prisma guidelines. Were included 13 series and a total number of 527 patients, who underwent 541 surgeries. We paid particular attention to operative time, rate of intraoperative seizures, rate of initial complete resection at the time of first IoMRI, the final complete gross total resection (GTR, complete radiological resection rates), and the immediate and definitive postoperative neurological complications. The mean duration of surgery was 6.3 h (median 7.05, range 3.8-7.9). The intraoperative seizure rate was 3.7% (range 1.4-6; I^2 = 0%, P heterogeneity = 0.569, standard error = 0.012, p = 0.002). The intraoperative complete resection rate at the time of first IoMRI was 35.2% (range 25.7-44.7; I^2 = 66.73%, P heterogeneity = 0.004, standard error = 0.048, p < 0.001). The rate of patients who underwent supplementary resection after one or several IoMRI was 46% (range 39.8-52.2; I^2 = 8.49%, P heterogeneity = 0.364, standard error = 0.032, p < 0.001). The GTR rate at discharge was 56.3% (range 47.5-65.1; I^2 = 60.19%, P heterogeneity = 0.01, standard error = 0.045, p < 0.001). The rate of immediate postoperative complications was 27.4% (range 15.2-39.6; I^2 = 92.62%, P heterogeneity < 0.001, standard error = 0.062, p < 0.001). The rate of permanent postoperative complications was 4.1% (range 1.3-6.9; I^2 = 38.52%, P heterogeneity = 0.123, standard error = 0.014, p = 0.004). Combined use of awake craniotomy and IoMRI can help in maximizing brain tumor resection in selected patients. The technical obstacles to doing so are not severe and can be managed by experienced neurosurgery and anesthesiology teams. The benefits of bringing these technologies to bear on patients with brain tumors in or near language areas are obvious. The lack of equipoise on this topic by experienced practitioners will make it difficult to do a prospective, randomized, clinical trial. In the opinion of the authors, such a trial would be unnecessary and would deprive some patients of the benefits of the best available methods for their tumor resections.
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Ghinda DC, Yang Y, Wu S, Lu J, Su L, Damiani S, Tumati S, Jansen G, Duffau H, Wu JS, Northoff G. Personalized Multimodal Demarcation of Peritumoral Tissue in Glioma. JCO Precis Oncol 2020; 4:1128-1140. [PMID: 35050774 DOI: 10.1200/po.20.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Gliomas are life-threatening brain tumors, and the extent of surgical resection is one of the strongest influences on survival rate. However, the proper distinction of infiltrated tissue remains elusive. The aim of this study was to use multimodal analyses to demarcate peritumoral tissue (PT) from tumoral (TT) and healthy tissue (HT). METHODS A total of 40 patients with histologically confirmed glioma were recruited. We analyzed resting-state functional magnetic resonance imaging (rs-fMRI) using the voxel-based mean blood-oxygen-level-dependent (BOLD) signal and the corresponding structural MRI (s-MRI) alongside RNA sequencing, whole-exome sequencing, and histology results of biopsy samples obtained from PT, HT, and TT. RESULTS We demarcated a functionally defined PT area where the mean BOLD signal gradually decreased near the edge of the tumor and extended beyond the TT borders (as defined by s-MRI), which was confirmed on a case-by-case basis. Correspondingly, genetic analyses showed a gene expression pattern and mutational landscape of the PT that were distinct from that seen in HT and TT. The genetic characterization of PT relative to HT and TT converged with the MRI-defined PT zones. This was confirmed in three individual cases after additional histologic analysis. A wider PT was associated with a longer progression-free survival, which suggests PT might act as an intermediate area between TT and HT. CONCLUSION Combined multimodal imaging and genetic analyses can allow for an objective demarcation of the PT in glioma and a robust classification of the degree of infiltration of the PT. These findings could help improve both neurosurgical resection and radio-oncologic therapy.
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Affiliation(s)
- Diana C Ghinda
- Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Yufei Yang
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Shuai Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junfeng Lu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lan Su
- Genetron Health (Beijing) Co Ltd, Beijing, China
| | - Stefano Damiani
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Shankar Tumati
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
| | - Gerard Jansen
- Department of Neuropathology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France.,Brain Plasticity, Stem Cells, and Glial Tumors Team, National Institute for Health and Medical Research, Montpellier, France
| | - Jin-Song Wu
- Glioma Surgery Division, Neurologic Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Georg Northoff
- Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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Lahiff MN, Ghali MGZ. The Ethical Dilemma in the Surgical Management of Low Grade Gliomas According to the Variable Availability of Resources and Surgeon Experience. Asian J Neurosurg 2020; 15:266-271. [PMID: 32656117 PMCID: PMC7335147 DOI: 10.4103/ajns.ajns_296_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/20/2019] [Indexed: 11/04/2022] Open
Abstract
Low grade gliomas (LGGs) affect young individuals in the prime of life. Management may alternatively include biopsy and observation or surgical resection. Recent evidence strongly favors maximal and supramaximal resection of LGGs in optimizing survival metrics. Awake craniotomy with cortical mapping and electrical stimulation along with other preoperative and intraoperative surgical adjuncts, including intraoperative magnetic resonance and diffusion tensor imaging, facilitates maximization of resection and eschews precipitating neurological deficits. Intraoperative imaging permits additional resection of identified residual to be completed within the same surgical session, improving extent of resection and consequently progression free and overall survival. These resources are available in only a few centers throughout the United States, raising an ethical dilemma as to where patients harboring LGGs should most appropriately be treated.
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Affiliation(s)
- Marshall Norman Lahiff
- School of Law, University of Miami, Miami, Florida, USA.,Walton Lantaff Schoreder and Carson LLP, Miami, Florida, USA
| | - Michael George Zaki Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, Philadelphia, Pennsylvania, USA.,Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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6
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Tang Z, Xu Y, Jin L, Aibaidula A, Lu J, Jiao Z, Wu J, Zhang H, Shen D. Deep Learning of Imaging Phenotype and Genotype for Predicting Overall Survival Time of Glioblastoma Patients. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:2100-2109. [PMID: 31905135 PMCID: PMC7289674 DOI: 10.1109/tmi.2020.2964310] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Glioblastoma (GBM) is the most common and deadly malignant brain tumor. For personalized treatment, an accurate pre-operative prognosis for GBM patients is highly desired. Recently, many machine learning-based methods have been adopted to predict overall survival (OS) time based on the pre-operative mono- or multi-modal imaging phenotype. The genotypic information of GBM has been proven to be strongly indicative of the prognosis; however, this has not been considered in the existing imaging-based OS prediction methods. The main reason is that the tumor genotype is unavailable pre-operatively unless deriving from craniotomy. In this paper, we propose a new deep learning-based OS prediction method for GBM patients, which can derive tumor genotype-related features from pre-operative multimodal magnetic resonance imaging (MRI) brain data and feed them to OS prediction. Specifically, we propose a multi-task convolutional neural network (CNN) to accomplish both tumor genotype and OS prediction tasks jointly. As the network can benefit from learning tumor genotype-related features for genotype prediction, the accuracy of predicting OS time can be prominently improved. In the experiments, multimodal MRI brain dataset of 120 GBM patients, with as many as four different genotypic/molecular biomarkers, are used to evaluate our method. Our method achieves the highest OS prediction accuracy compared to other state-of-the-art methods.
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7
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Abstract
Over the past decade, there has been an unprecedented level of interest and progress into understanding visual processing in the brain of the deaf. Specifically, when the brain is deprived of input from one sensory modality (such as hearing), it often compensates with supranormal performance in one or more of the intact sensory systems (such as vision). Recent psychophysical, functional imaging, and reversible deactivation studies have converged to define the specific visual abilities that are enhanced in the deaf, as well as the cortical loci that undergo crossmodal plasticity in the deaf and are responsible for mediating these superior visual functions. Examination of these investigations reveals that central visual functions, such as object and facial discrimination, and peripheral visual functions, such as motion detection, visual localization, visuomotor synchronization, and Vernier acuity (measured in the periphery), are specifically enhanced in the deaf, compared with hearing participants. Furthermore, the cortical loci identified to mediate these functions reside in deaf auditory cortex: BA 41, BA 42, and BA 22, in addition to the rostral area, planum temporale, Te3, and temporal voice area in humans; primary auditory cortex, anterior auditory field, dorsal zone of auditory cortex, auditory field of the anterior ectosylvian sulcus, and posterior auditory field in cats; and primary auditory cortex and anterior auditory field in both ferrets and mice. Overall, the findings from these studies show that crossmodal reorganization in auditory cortex of the deaf is responsible for the superior visual abilities of the deaf.
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8
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Hsu AL, Hou P, Johnson JM, Wu CW, Noll KR, Prabhu SS, Ferguson SD, Kumar VA, Schomer DF, Hazle JD, Chen JH, Liu HL. IClinfMRI Software for Integrating Functional MRI Techniques in Presurgical Mapping and Clinical Studies. Front Neuroinform 2018; 12:11. [PMID: 29593520 PMCID: PMC5854683 DOI: 10.3389/fninf.2018.00011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/23/2018] [Indexed: 01/25/2023] Open
Abstract
Task-evoked and resting-state (rs) functional magnetic resonance imaging (fMRI) techniques have been applied to the clinical management of neurological diseases, exemplified by presurgical localization of eloquent cortex, to assist neurosurgeons in maximizing resection while preserving brain functions. In addition, recent studies have recommended incorporating cerebrovascular reactivity (CVR) imaging into clinical fMRI to evaluate the risk of lesion-induced neurovascular uncoupling (NVU). Although each of these imaging techniques possesses its own advantage for presurgical mapping, a specialized clinical software that integrates the three complementary techniques and promptly outputs the analyzed results to radiology and surgical navigation systems in a clinical format is still lacking. We developed the Integrated fMRI for Clinical Research (IClinfMRI) software to facilitate these needs. Beyond the independent processing of task-fMRI, rs-fMRI, and CVR mapping, IClinfMRI encompasses three unique functions: (1) supporting the interactive rs-fMRI mapping while visualizing task-fMRI results (or results from published meta-analysis) as a guidance map, (2) indicating/visualizing the NVU potential on analyzed fMRI maps, and (3) exporting these advanced mapping results in a Digital Imaging and Communications in Medicine (DICOM) format that are ready to export to a picture archiving and communication system (PACS) and a surgical navigation system. In summary, IClinfMRI has the merits of efficiently translating and integrating state-of-the-art imaging techniques for presurgical functional mapping and clinical fMRI studies.
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Affiliation(s)
- Ai-Ling Hsu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jason M Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Changwei W Wu
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Donald F Schomer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jyh-Horng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Xiao Y, Eikenes L, Reinertsen I, Rivaz H. Nonlinear deformation of tractography in ultrasound-guided low-grade gliomas resection. Int J Comput Assist Radiol Surg 2018; 13:457-467. [DOI: 10.1007/s11548-017-1699-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/21/2017] [Indexed: 11/24/2022]
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10
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Lu J, Zhang H, Hameed NUF, Zhang J, Yuan S, Qiu T, Shen D, Wu J. An automated method for identifying an independent component analysis-based language-related resting-state network in brain tumor subjects for surgical planning. Sci Rep 2017; 7:13769. [PMID: 29062010 PMCID: PMC5653800 DOI: 10.1038/s41598-017-14248-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 10/09/2017] [Indexed: 02/08/2023] Open
Abstract
As a noninvasive and “task-free” technique, resting-state functional magnetic resonance imaging (rs-fMRI) has been gradually applied to pre-surgical functional mapping. Independent component analysis (ICA)-based mapping has shown advantage, as no a priori information is required. We developed an automated method for identifying language network in brain tumor subjects using ICA on rs-fMRI. In addition to standard processing strategies, we applied a discriminability-index-based component identification algorithm to identify language networks in three different groups. The results from the training group were validated in an independent group of healthy human subjects. For the testing group, ICA and seed-based correlation were separately computed and the detected language networks were assessed by intra-operative stimulation mapping to verify reliability of application in the clinical setting. Individualized language network mapping could be automatically achieved for all subjects from the two healthy groups except one (19/20, success rate = 95.0%). In the testing group (brain tumor patients), the sensitivity of the language mapping result was 60.9%, which increased to 87.0% (superior to that of conventional seed-based correlation [47.8%]) after extending to a radius of 1 cm. We established an automatic and practical component identification method for rs-fMRI-based pre-surgical mapping and successfully applied it to brain tumor patients.
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Affiliation(s)
- Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Han Zhang
- Department of Radiology and Biomedical Research Imaging Center (BRIC), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N U Farrukh Hameed
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiwen Yuan
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianming Qiu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dinggang Shen
- Department of Radiology and Biomedical Research Imaging Center (BRIC), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841, Republic of Korea.
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
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11
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Qiu TM, Gong FY, Gong X, Wu JS, Lin CP, Biswal BB, Zhuang DX, Yao CJ, Zhang XL, Lu JF, Zhu FP, Mao Y, Zhou LF. Real-Time Motor Cortex Mapping for the Safe Resection of Glioma: An Intraoperative Resting-State fMRI Study. AJNR Am J Neuroradiol 2017; 38:2146-2152. [PMID: 28882861 DOI: 10.3174/ajnr.a5369] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/25/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Resting-state functional MR imaging has been used for motor mapping in presurgical planning but never used intraoperatively. This study aimed to investigate the feasibility of applying intraoperative resting-state functional MR imaging for the safe resection of gliomas using real-time motor cortex mapping during an operation. MATERIALS AND METHODS Using interventional MR imaging, we conducted preoperative and intraoperative resting-state intrinsic functional connectivity analyses of the motor cortex in 30 patients with brain tumors. Factors that may influence intraoperative imaging quality, including anesthesia type (general or awake anesthesia) and tumor cavity (filled with normal saline or not), were studied to investigate image quality. Additionally, direct cortical stimulation was used to validate the accuracy of intraoperative resting-state fMRI in mapping the motor cortex. RESULTS Preoperative and intraoperative resting-state fMRI scans were acquired for all patients. Fourteen patients who successfully completed both sufficient intraoperative resting-state fMRI and direct cortical stimulation were used for further analysis of sensitivity and specificity. Compared with those subjected to direct cortical stimulation, the sensitivity and specificity of intraoperative resting-state fMRI in localizing the motor area were 61.7% and 93.7%, respectively. The image quality of intraoperative resting-state fMRI was better when the tumor cavity was filled with normal saline (P = .049). However, no significant difference between the anesthesia types was observed (P = .102). CONCLUSIONS This study demonstrates the feasibility of using intraoperative resting-state fMRI for real-time localization of functional areas during a neurologic operation. The findings suggest that using intraoperative resting-state fMRI can avoid the risk of intraoperative seizures due to direct cortical stimulation and may provide neurosurgeons with valuable information to facilitate the safe resection of gliomas.
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Affiliation(s)
- T-M Qiu
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - F-Y Gong
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - X Gong
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - J-S Wu
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - C-P Lin
- Center for Computational Systems Biology (C.-p.L.), Fudan University, Shanghai, China
| | - B B Biswal
- Department of Biomedical Engineering (B.B.B.), New Jersey Institute of Technology, Newark, New Jersey
| | - D-X Zhuang
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - C-J Yao
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - X-L Zhang
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - J-F Lu
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - F-P Zhu
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Y Mao
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - L-F Zhou
- From the Department of Neurological Surgery (T.-m.Q., F.-y.G., X.G., J.-s.W., D.-x.Z., C.-j.Y., X.-l.Z., J.-f.L., F.-p.Z., Y.M., L.-f.Z.), Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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12
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Ghinda D, Zhang N, Lu J, Yao CJ, Yuan S, Wu JS. Contribution of combined intraoperative electrophysiological investigation with 3-T intraoperative MRI for awake cerebral glioma surgery: comprehensive review of the clinical implications and radiological outcomes. Neurosurg Focus 2016; 40:E14. [PMID: 26926054 DOI: 10.3171/2015.12.focus15572] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aimed to assess the clinical efficiency of combined awake craniotomy with 3-T intraoperative MRI (iMRI)-guided resection of gliomas adjacent to eloquent cortex performed at a single center. It also sought to explore the contribution of iMRI to surgeons' learning process of maximal safe resection of gliomas. METHODS All patients who underwent an awake craniotomy and iMRI for resection of eloquent area glioma during the 53 months between January 2011 and June 2015 were included. The cases were analyzed for short- and long-term neurological outcome, progression-free survival (PFS), overall survival (OS), and extent of resection (EOR). The learning curve was assessed after dividing the cohort into Group A (first 27 months) and Group B (last 26 months). Statistical analyses included univariate logistic regression analysis on clinical and radiological variables. Kaplan-Meier and Cox regression models were used for further analysis of OS and PFS. A p value < 0.05 was considered statistically significant. RESULTS One hundred six patients were included in the study. Over an average follow-up period of 24.8 months, short- and long-term worsening of the neurological function was noted in 48 (46.2%) and 9 (8.7%) cases, respectively. The median and mean EOR were 100% and 92%, respectively, and complete radiographic resection was achieved in 64 (60.4%) patients. The rate of gross-total resection (GTR) in the patients with low-grade glioma (89.06% ± 19.6%) was significantly lower than that in patients with high-grade glioma (96.4% ± 9.1%) (p = 0.026). Thirty (28.3%) patients underwent further resection after initial iMRI scanning, with a 10.1% increase of the mean EOR. Multivariate Cox proportional hazards modeling demonstrated that the final EOR was a significant predictor of PFS (HR 0.225, 95% CI 0.070-0.723, p = 0.012). For patients with high-grade glioma, the GTR (p = 0.033), the presence of short-term motor deficit (p = 0.027), and the WHO grade (p = 0.005) were independent prognostic factors of OS. Performing further resection after the iMRI (p = 0.083) and achieving GTR (p = 0.05) demonstrated a PFS benefit trend for the patients affected by a low-grade glioma. Over time, the rate of performing further resection after an iMRI decreased by 26.1% (p = 0.005). A nonsignificant decrease in the rate of short-term (p = 0.101) and long-term (p = 0.132) neurological deficits was equally noted. CONCLUSIONS Combined awake craniotomy and iMRI is a safe and efficient technique allowing maximal safe resection of eloquent area gliomas with possible subsequent OS and PFS benefits. Although there is a learning curve for applying this technique, it can also improve the surgeon's ability in eloquent glioma surgery.
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Affiliation(s)
- Diana Ghinda
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; and.,Department of Neurosurgery, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Nan Zhang
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; and
| | - Junfeng Lu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; and
| | - Cheng-Jun Yao
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; and
| | - Shiwen Yuan
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; and
| | - Jin-Song Wu
- Glioma Surgery Division, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; and
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13
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Wu J, Lu J, Zhang H, Zhang J, Yao C, Zhuang D, Qiu T, Guo Q, Hu X, Mao Y, Zhou L. Direct evidence from intraoperative electrocortical stimulation indicates shared and distinct speech production center between Chinese and English languages. Hum Brain Mapp 2015; 36:4972-85. [PMID: 26351094 DOI: 10.1002/hbm.22991] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 08/03/2015] [Accepted: 08/24/2015] [Indexed: 11/11/2022] Open
Abstract
Chinese processing has been suggested involving distinct brain areas from English. However, current functional localization studies on Chinese speech processing use mostly "indirect" techniques such as functional magnetic resonance imaging and electroencephalography, lacking direct evidence by means of electrocortical recording. In this study, awake craniotomies in 66 Chinese-speaking glioma patients provide a unique opportunity to directly map eloquent language areas. Intraoperative electrocortical stimulation was conducted and the positive sites for speech arrest, anomia, and alexia were identified separately. With help of stereotaxic neuronavigation system and computational modeling, all positive sites elicited by stimulation were integrated and a series of two- and three-dimension Chinese language probability maps were built. We performed statistical comparisons between the Chinese maps and previously derived English maps. While most Chinese speech arrest areas located at typical language production sites (i.e., 50% positive sites in ventral precentral gyrus, 28% in pars opercularis and pars triangularis), which also serve English production, an additional brain area, the left middle frontal gyrus (Brodmann's areas 6/9), was found to be unique in Chinese production (P < 0.05). Moreover, Chinese speakers' inferior ventral precentral gyrus (Brodmann's area 6) was used more than that in English speakers. Our finding suggests that Chinese involves more perisylvian region (extending to left middle frontal gyrus) than English. This is the first time that direct evidence supports cross-cultural neurolinguistics differences in human beings. The Chinese language atlas will also helpful in brain surgery planning for Chinese-speakers.
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Affiliation(s)
- Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Junfeng Lu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Han Zhang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, China.,Department of Radiology and BRIC, University of North Carolina at Chapel Hill, North Carolina
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengjun Yao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongxiao Zhuang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Tianming Qiu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Qihao Guo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaobing Hu
- Department of Anesthesia, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liangfu Zhou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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14
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Hulou MM, Cote DJ, Olubiyi OI, Smith TR, Chiocca EA, Johnson MD. Awake right hemisphere brain surgery. J Clin Neurosci 2015; 22:1921-7. [PMID: 26279501 DOI: 10.1016/j.jocn.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 11/27/2022]
Abstract
We report the indications and outcomes of awake right hemispheric brain surgery, as well as a rare patient with crossed aphasia. Awake craniotomies are often performed to protect eloquent cortex. We reviewed the medical records for 35 of 96 patients, in detail, who had awake right hemisphere brain operations. Intraoperative cortical mapping of motor and/or language function was performed in 29 of the 35 patients. A preoperative speech impairment and left hand dominance were the main indicators for awake right-sided craniotomies in patients with right hemisphere lesions. Four patients with lesion proximity to eloquent areas underwent awake craniotomies without cortical mapping. In addition, one patient had a broncho-pulmonary fistula, and another had a recent major cardiac procedure that precluded awake surgery. An eloquent cortex representation was identified in 14 patients (48.3%). Postoperatively, seven of 17 patients (41.1%) who presented with weakness, experienced improvements in their motor functions, 11 of 16 (68.7%) with seizures became seizure-free, and seven of nine (77.7%) with moderate to severe headaches and one of two with a visual field deficit improved significantly. There were also improvements in speech and language functions in all patients who presented with speech difficulties. A right sided awake craniotomy is an excellent option for left handed patients, or those with right sided cortical lesions that result in preoperative speech impairments. When combined with intraoperative cortical mapping, both speech and motor function can be well preserved.
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Affiliation(s)
- M Maher Hulou
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - David J Cote
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Olutayo I Olubiyi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Mark D Johnson
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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15
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Chen L, Mao Y. Gross total resection plays a leading role in survival of patients with glioblastoma multiforme. World Neurosurg 2014; 82:e105-7. [PMID: 24802844 DOI: 10.1016/j.wneu.2014.04.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
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